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, ^^ �_ <br />Date " �O �/ �QSTING �� publicWorksPormlix ��_— <br />eine. oeo�. + <br />qpplication For <br />PUBLIC WOI�KS PCRMIT P��bTozlFeeFee a-- � <br />.� <br />IL¢55 AppL F¢¢ b��a § <br />Balance Duo $ _J� <br />Print or Type Only <br />i i l OF <br />Owner <br />l.uE57 <br />MaiVina <br />Zip <br />City Zip Phone <br />' �/ <br />�t /� 'T.10 '3C��J (r�ILIUi/ �/N�F,f�'/•�wN STiJIAIi�F TAN%(S !l/1D <br />Describe Propoaed Work ^ <br />liJ ST!-1�L i7 hlri�) 11[i/1 i:r9[.tD/�/ G_ST /r,�PLuDi�/G S/DF/VA[K_ Rr-5%Orf�i-ITi�ry <br />- - _ _. � _ .1._..i...� �r:�.�-�n. i..�'-=i4ii L1Ti��ri AT �R�G � <br />:r <br />Project Address (if knowe) ��= <br />Attach foai (4) copies o( plans fur proposed work - Draw to scale and noie fhe following as applicable: <br />! Property Lines • Centerline of sireet <br />� Outline and dimensions ot all existing and • Indicate North <br />proposed structures on the lot • Show any propoa� �.rading changes <br />O Ezisting and proposed utilities • Show measuremer .c. <br />� - ! . PERIAIT CONDITIONS <br />�� � 7. All c�l,s fcr inspection shall be made 24 hrs. in advance- phone 259-8810. <br />� I 2. All ��ork �hall be performed in accordance wi!h this permit and current City of Everett Design and Construction <br />��i::.^.dcr�+� ar�d Specifications. <br />�, f��• �cq� n Ur�der rounc� �rv ceb48 F�rs. l�efor� ou di�.�OLL FREE N�MBER 1-800•424•§555. <br />I �. di e'� g�ii n 9rum u oi a so en ma �nai a uae empty � gaaon drum bcaiea ncar U�e <br />tueGng arta to be used to cban op any accidenial spiNs. <br />5. A sign or signs IrniicaUng the bcatioa of thr pump shul o(t sv�tches shal be instat!ed. <br />��. f�5 �x; �7i��, ���.ied i/z-7/�� s <br />fo� Const <br />l� �-n ec�iok5 b <br />FINAL INSPECTIO <br />Approved as Constructed <br />a' PUBLIC WORKS DEPARTME�T <br />3200 Cedar Sireet <br />Everett, WA 98201 <br />Phone:259�8810 <br />I l � 9�F <br />Date <br />�/v • �N1 <br />Datza <br />��'L <br />b� V Nou�l�. (�+�-t���Gtid� <br />ACKNOWLEDGEME"!-� OF CONDITIONS <br />W <br />� <br />vw <br />� / <br />� <br />O <br />The unde�signed owner/applicant hen:by agrees lo hold and save harm- <br />less the City of Everett irom any ai,d all claims lor damages, costs, <br />ezpenses, or causes of action that may arise because ol inslallation <br />and maintanance of the improverQent or other righ4ol-way use hereto <br />applied for and furiher a rees to remove same upon notice from the <br />Cit an to replace public�roperry damaged thereby. <br />� / iu I <br />/ i nature of Applicant � ate <br />WORK AUTHORIZ[D BY T� IS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE UILIGENTLY PURSUED TO COMPLETION. ?HIS PERId1T MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />♦ <br />